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Laparoscopic Rectopexy

  • Author: Leandro Feo, MD; Chief Editor: Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS  more...
Updated: Aug 11, 2014


Rectal prolapse is a debilitating condition that affects 1% of people older than 60 years. Surgical approaches to its treatment include a perineal approach and an abdominal approach.[1] Laparoscopic rectopexy was initially described in the early 1990s and has since become the abdominal procedure of choice for rectal prolapse.[2] This review describes three of the current laparoscopic approaches in the management of rectal prolapse and rectocele.



Once rectal prolapse is diagnosed, surgical repair is indicated to prevent worsening fecal incontinence and discomfort.



Abdominal rectopexy yields low recurrence rates (< 5%) and some improvement of incontinence. However, this approach can cause constipation and does not resolve existing constipation,[3, 4] possibly owing to rectal denervation after the posterolateral dissection of the rectum.

In contrast, perineal approaches, including Altemeier and Delorme procedures, are associated with a higher recurrence rate but lower morbidity than open abdominal approaches. Although considered safer operations, with the rate of recurrence approaching 18% and minimal improvement in continence, better alternatives have been investigated.[3]

The small incisions, lack of anastomosis, and low recurrence rates of the minimally invasive approach have reduced the morbidity of the abdominal approach without affecting efficacy. In a randomized control trial, laparoscopic rectopexy had fewer complications, shorter length of hospital stay, and decreased in pain compared with open abdominal rectopexy.[5] In addition, the morbidity was comparable to perineal procedures.

Compared with the classic open posterior rectopexy, laparoscopic rectopexy has similar functional outcomes regarding constipation. Satisfactory long-term results have been reported with laparoscopic "ventral" rectopexy, and new constipation is prevented because of the lack of posterior dissection.[6, 7, 8, 9]

Compared with laparoscopic rectopexy, results of robotic rectopexy are similar in terms of length of stay, postoperative pain, recurrence, and mortality rates. In contrast, robotic rectopexy is associated with a longer operative time and higher costs.[10, 11, 12]

Contributor Information and Disclosures

Leandro Feo, MD Resident Physician, Department of General Surgery, Hahnemann University Hospital, Drexel University College of Medicine

Leandro Feo, MD is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.


David E Stein, MD Chief, Division of Colorectal Surgery, Associate Professor, Department of Surgery, Director, Mini-Medical School Program, Drexel University College of Medicine; Chief, Division of Colorectal Surgery, Department of Surgery, Hahneman University Hospital; Consultant, Merck; Consultant, Ethicon Endo-Surgery; Consultant, Health Partners; Consultant, Cook Surgical

David E Stein, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, Association for Surgical Education, Pennsylvania Medical Society, Society for Surgery of the Alimentary Tract, Crohn's and Colitis Foundation of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Merck<br/>Serve(d) as a speaker or a member of a speakers bureau for: Merck.

Chief Editor

Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Surgeons of England, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

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